PPS Credential Application (for PDF version click here)

Dr. Diane Harris, Graduate Coordinator – (415) 338-7064 dharris@sfsu.edu

The Pupil Personnel Services Credential is the third-year internship program, which is

meant to follow the two-year Graduate Program in School Psychology. In addition to the

courses required for the M.S. in Psychology with a concentration in School Psychology, the

following courses are required for the Pupil Personnel Services Credential with a School

Psychology authorization. Students enrolled in the M.S. in Psychology with a concentration

in School Psychology at SFSU are eligible for this Program, as well as are any outside

applicants who hold an M.S. degree in School Psychology or other related field.

Psychology Department Website: http://www.sfsu.edu/~psych/

      Dear Prospective Applicant:

Enclosed is the application for the School Psychology Internship Program. Please follow closely the instructions in this letter and in the enclosed application.

ü Complete the enclosed application and return the application with accompanying documents along with the processing fee of one-hundred and fifty dollars ($150.00/

new applicant) or one-hundred dollars ($100.00/re-applicant) to the:

            Graduate Secretary

                                          Psychology Department (PPS), EP 301

                                          San Francisco State University

                                          1600 Holloway Avenue

                                          San Francisco, California 94132-4168

ü      Make checks for the processing fee payable to: San Francisco State University College of Extended Learning.  Neither credit cards nor cash will be accepted.

ü      Do not complete an application for the University graduate division nor pay a University fee to the Graduate Division.

ü      The application due date is March  1^st 2009.

ü      Once your application is received, you will be notified regarding the status of your application.

ü      To remind you of the requirements for admission to the Program, the following

       prerequisites are necessary:

v     At least a Master of Science Degree in Psychology with a concentration in School

        Psychology or a related master’s or doctorate degree;

v     Completion of a minimum of 576 hours of supervised field experience, which

        demonstrates skill and knowledge in the areas of assessment, intervention, program

        evaluation, consultation, group assessment, and collaboration with community

        agencies.  This field experience also must demonstrate skills in applying

        psychological theory, legal principles, ethical principles and educational

        and psychological research. An experienced practitioner with a PPS credential must

        supervise the entire field experience.

v Completion of the GRE within the last 7 years.

v Must Pass all subject areas of the CBEST.

v    Compliance with the California Commission on Teacher Credentialing (CCTC) and

        the National Association of School Psychologists (NASP) standards that are typically

         met during the first two years of the Master of Science degree in Psychology with a

        concentration of School Psychology. These standards include:

Knowledge of:                               

·         Growth and Development

·         Socio-Cultural Influences

·         Assessment

·         Problem Prevention and Early Intervention

·         Consultation Services

·         Learning Theory and Psychological Education

·         Psychological theory including psychodynamic, family systems, and

       object relations orientations

§         Research and evaluation methods, statistics and measurement

·         Program/Service coordination and Development

·         Legal and ethical standards

·         Individual Development

·         Biological bases of behavior

·         Organization and operation of schools

·         Instructional design

·         Emergent technologies

·         Alternative models for the delivery of school psychological services

·         Roles and functions of a School Psychologist

Skills in:

§         Assessment

§         Individual Intervention

§         Group intervention

§         Individual evaluation

§         Consultation and other indirect interventions

§         Group assessment

§         Program evaluation

§         Utilizing legal aspects

§         Using community resources

§         Research and evaluation methods, statistics and measurement

§         Professional ethical conduct

§         Diversity

ü      To meet these requirements, several documents must be submitted with the application.

        Supplemental documents are indicated on page 7 of the application.

ü      If there are questions regarding the application, you may contact Ms. Tina Perdices by

        e-mail at tperdices@marin.k12.ca.us or phone at (415) 454-2162 ext.113 ; and if there are general questions regarding

        the School Psychology program, you may contact the coordinator, Dr. Diane Harris at (415) 338-7064; and if

        there are questions regarding the availability of the application, contact the graduate secretary’s office at (415) 338-2711.

ü      Evaluation of transcripts will not be conducted until the School Psychology Internship Application is submitted.

Sincerely,

Diane Harris, Ph.D.

Coordinator, School Psychology Program

Encl: Application for the School Psychology Internship Program

                                             San Francisco State University

SCHOOL PSYCHOLOGY INTERNSHIP PROGRAM APPLICATION

    Offered jointly between the Psychology Department and the College of Extended Learning

                                    Admission for Fall _________

Name:______________________________________________SS# _____/_____/_____

            (Last)                                      (First)                                  (Middle Initial)

Address:_________________________________________________________________

              _________________________________________________________________

                        (City)                                           (State)                                         (Zip)

Home Phone: (______)_______________            Work Phone: (______)______________

e-mail address: ____________________________________       DOB____/_____/_____

Optional Questions:  Age________    Gender_______     Ethnicity ________________           

Have you applied to the Psy department before?______   If “yes”, what semester:________

Are you a continuing student at SFSU? ________ 

Department/Program:_______________________   Date of enrollment:______________

Graduate Degree (type/ major)_______________________________________________

College/University_________________________________________________________

Date Received____________________________________________________________

Undergraduate Degree (type/ major)___________________________________________

College/University_________________________________________________________

Date Received____________________________________________________________

Have you taken the GRE within the past 7 years? ___________       Date______________

Scores: English_________                  Quantitative___________      Analytical__________

If not, scheduled date to take GRE: _______________________

Have you passed all subject areas of CBEST? ______________       Date _____________

Scores: Reading _________                Mathematics __________       Writing____________

Do you have a teaching/education credential? _________               

Type & State  ____________________________________             Date______________

Type & State  ____________________________________             Date______________

If not currently credentialed, are you approved for a Certificate of Clearance in CA?______

Date ______   If not, have you applied to the Credentials Office ______  When?  _______

Do you have any related credentials or licenses (e.g., MFT, counseling?)  _______________

Type & State  ___________________________________               Date______________

Type & State  ___________________________________               Date______________

 Print the names and locations of all Colleges and Universities attended and attending.  List

most recent first.

List previous related graduate- level coursework in psychology, education, counseling:

Please respond to the following questions regarding your fieldwork experiences

(psychologically-related work with children).  You may copy this page to complete this

list for each year of fieldwork experience.  Do not combine years of experiences:

Date/Year: ________             First Year_____     Second Year_____       Third Year______

Other/explain____________________________________

SchoolSite/District/Agency:_________________________________________________

Age Group/Population Served: ______________________________________________

Name of Supervisor: ______________________________  Phone No. ______________

(We reserve the right to contact your supervisor.)

Was your supervisor a credentialed School Psychologist?     Yes ______         No________

State:________           National (NCSP): _________            

Was your supervisor credentialed/licensed in a related field? Yes ______       No _______

(e.g., LEP, MFT, MFCC, LCSW, License in Psychology)  

Which /license?________________________________________          State: ________

How often did you meet with your supervisor? ___________      Indiv. ____  Group ____________

Fieldwork Activities                          # of hours                  briefly describe experience

Assessment/Evaluation

Direct Intervention

(clinical work/ counseling)

Consultation

(staff/classroom interventions//families)

Case Review/ Team Consultation

(e.g., Student Study Team)

Professional Development

(conferences, seminars)

Please submit the following items with your application:

1.______         Completed Applicant-Previous Coursework Evaluation Form

                        (sent in your application packet)

2.______         Copy of official or unofficial transcripts (graduate coursework)..

3.______         Copy of graduate course syllabi or detailed course descriptions.

4.______         Copy of GRE scores (taken within past 7 years).

5.______         Copy of CBEST passage and scores.

6.______         3 letters of recommendation (at least 1 of which must be from a credentialed

                        School Psychologists).

7.______         Copy of Psychological Report on a child or adolescent written by you

                        (MUST delete all identifying information).

6.______         Certificate of Clearance (obtained from the Credentials Office) for the state

                        of CA  or copy of current credential issued by the CCTC.

7.______         Check for New Applicant fee/$150.00 or Re-applicant fee/ $100.00,

                         made payable to SFSU College of Extended Learning. 

___________________________________________________________

I hereby certify (or declare) under penalty of perjury that all the foregoing statements in this

application are true and correct.

Date__________________    City_________________________    State___________

Signature of Applicant:___________________________________________________

                     School Psychology Internship Program

    Applicant- Previous Coursework Evaluation Form

Applicant Name: ___________________________________________

    Instructions:  Please complete this matrix to the best of your ability based upon your previous

graduate coursework and fieldwork. In the column titled “Previous graduate coursework that

meets standard”, write in the course name and number (e.g., Psy 735) of courses in which the

standard was addressed through course content, course work, or fieldwork practice.  Some courses

will meet multiple standards, and some standards will be met by multiple courses.  Course syllabi,

assignments, and descriptions may help you in completing this matrix.  Also be aware that some of

these standards are met by courses in the School Psychology Internship Program, and thus you may

 not be able to complete the entire matrix based solely on your previous coursework.  Thus, it is

acceptable for parts of the matrix to be blank or incomplete.  The matrix will be used as a

guideline for program evaluators in considering your application and if you have met the prerequisite CCTC

and NASP standards.  

Standard 12 - Growth and Development. Each candidate demonstrates knowledge of normal and

abnormal growth and development, including relevant research and theories, and other information

related to pupil strengths and weaknesses that affect learning. Each candidate demonstrates knowledge

of the possible influence of culture, ethnicity, family, socio-economic status, and language on pupil development.

Standard 13 - Socio-Cultural Influences. Each candidate demonstrates knowledge of possible

effects of culture, ethnicity, lifestyle, ethnicity, family, socio-economic status, gender, sexual orientation,

language and values on pupils' progress in a school setting. This includes knowledge of the influence

of these factors on the delivery of pupil personnel services that facilitate pupil academic and career success.